Defining a safe corridor for trans-iliac pin placement in cats.

OBJECTIVE: To identify whether a theoretical predictable safe corridor is available in cats for placement of trans-iliac pins without the use of fluoroscopy. METHODS: Twenty-one cats with straight orthogonal normal pelvic radiographs were included. Two start points were evaluated: a midpoint and a dorsal point. The midpoint was defined as midway between the dorsal lamina of the sacral vertebral canal and the cranial dorsal iliac spine. The dorsal start point was 2 mm ventral to the cranial dorsal iliac spine. The pin was assumed to be driven at 90 degrees to the lateral face of the ilium, and considered surgeon accuracy was ±4 degrees from the perpendicular. The angular range and the distance between the iliac wings from the ventrodorsal radiograph were used to calculate the possible cross-sectional area and pin exit location if driven from one iliac wing to the other. The corridor was then evaluated for repeatability in six randomly selected cats. RESULTS: Vertebral foramina penetration risk was identified in some cats when using a 1.6 and 2 mm-diameter pin using the mid-iliac wing start point. The dorsal start point decreased the available pin placement area but reduced the risk of entering the hazardous zone for all pin sizes up to 2 mm. CONCLUSION AND RELEVANCE: A theoretical defined safe corridor is available for trans-iliac pin placement in cats between 2.0 and 5.5 kg. A 1.2-mm pin is the safest if using the mid-iliac wing start point. A more dorsal start point can accommodate up to a 2.0-mm pin if correctly aligned to the sacrum.

Enhancing clinical learning in the workplace: a qualitative study.

Workplace learning (WPL) is seen as an essential component of clinical veterinary education by the veterinary profession. This study sought to understand this type of learning experience more deeply. This was done utilising observations of students on intramural rotations (IMR) and interviews with students and clinical staff. WPL was seen as an opportunity for students to apply knowledge and develop clinical and professional skills in what is generally regarded as a safe, authentic environment. Clinical staff had clear ideas of what they expected from students in terms of interest, engagement, professionalism, and active participation, where this was appropriate. In contrast, students often did not know what to expect and sometimes felt under-prepared when entering the workplace, particularly in a new species area. With the support of staff acting as mentors, students learned to identify gaps in their knowledge and skills, which could then be addressed during specific IMR work placements. Findings such as these illustrate both the complexities of WPL and the diversity of different workplace settings encountered by the students.

Clinical veterinary students' perceptions of a 'Day one' skills guide.

Veterinary schools in the UK are required by the Royal College of Veterinary Surgeons to ensure that their students have attained essential 'Day one' skills (DOS) by graduation. To aid students' understanding of how they could satisfy this requirement, the Royal Veterinary College produced a DOS guide, which was distributed in the 2007 to 2008 academic year to students in the third and fourth years of the professional veterinary course. The same students were surveyed towards the end of the 2008 to 2009 session about the guide, when they were in the fourth and final years, to rate its usefulness and to indicate their perceived levels of competence, both currently and expected at graduation. Focus group discussions were subsequently conducted to explore the findings of the survey. Responses from 88 fourth-year (39 per cent) and 174 (87 per cent) final-year students revealed that while almost all respondents were aware of the DOS guide, their use of it was low. Final-year students rated themselves as being more competent than fourth-year students, but were less optimistic about their expected level of competence regarding several invasive procedures, which some students considered to be 'unattainable' by graduation, despite the apparent value of extramural studies and intramural rotations in providing opportunities for learning.

H1N1 infection in emergency surgery: A cautionary tale.

Pandemic 2009 influenza A H1N1 has spread rapidly since its first report in Mexico in March 2009. This is the first influenza pandemic in over 40 years and it atypically affects previously healthy young adults, with higher rates of morbidity and mortality. The medical literature has been inundated with reports of H1N1 infection, the majority found in critical care and internal medicine journals with a relative paucity in the surgical literature. Despite this, it remains an important entity that can impact greatly on acute surgical emergencies. We present a case of previously healthy 31-year-old male who underwent open appendectomy. His post-operative recovery was complicated by acute respiratory distress syndrome secondary to H1N1 infection. This case report highlights the impact that H1N1 virus can have on acute surgical emergencies and how it can complicate the post-operative course.

The prevalence of canine patellar luxation in three centres. Clinical features and radiographic evidence of limb deviation.

The medical records of 155 dogs with patellar luxation (PL) from three different centres were analysed. Each case was classified according to the nature of its luxation and any concurrent orthopaedic conditions plus the age at diagnosis were also noted. Measurements relating to angle of inclination (AOI) of the femoral neck and medio-lateral bowing of the femur and tibia at the stifle were also recorded. The femoral and tibial data were compared to dogs with another orthopaedic condition in a case-control assessment. Labradors were most commonly affected (21%). Most luxations were medial (92%) and 54% of affected dogs were female. The mean AOI of the hip was 148.95 degrees . There was a statistically significant difference between the stifles of dogs with PL compared to a control population. This study concluded that PL in large breeds is increasing. Lateral luxation was uncommon and was not associated exclusively with large breeds. Females were more likely to have PL than males and being female was a risk factor associated with coxa valga. There are significant differences in medio-lateral stifle conformation between dogs with PL and control dogs.

Approaches to defining day-one competency: a framework for learning veterinary skills.

Competency at graduation, in a variety of physical and attitudinal skills, is an essential outcome measure for courses training veterinary surgeons. The approach adopted by the Royal Veterinary College, London, to identify and define the expected skill competencies required of our veterinary undergraduates by the time of graduation is described. In addition, we demonstrate how this skill set was built into a framework that was aligned with other student learning objectives. This two-year project resulted in the publication of a day-one skills handbook, which was introduced to the college staff and students in 2007.

Epoxy putty external skeletal fixation for fractures of the four main metacarpal and metatarsal bones in cats and dogs.

The objective of this retrospective study was to report the clinical use, advantages, disadvantages, complications and outcome of an epoxy putty external skeletal fixator (EPESF) used for the repair of fractures of all four main metatarsal or metacarpal bones in a single limb in 11 dogs and 11 cats. The aim of this technique was to achieve satisfactory alignment of the proximal and distal joints and the digits, rather than anatomical reconstruction of the metacarpal/metatarsal bones themselves. All of the cases achieved fracture union and they all recovered fully without any residual lameness.

Effect of passive stretching on the range of motion of osteoarthritic joints in 10 labrador retrievers.

Ten labrador retrievers and their owners undertook a programme to determine the effect of passive stretching on the dogs' osteoarthritic joints, which had a restricted range of motion. The range of motion of the joints was measured before and after the 21-day study, during which the owners performed 10 passive stretches for a hold of 10 seconds twice daily. Goniometric measurements showed that the passive stretching had significantly increased the range of motion of the joints.

Digital analysis of ulnar trochlear notch sclerosis in Labrador retrievers.

OBJECTIVES: To compare ulnar trochlear notch bone radiopacity in Labrador retrievers with and without fragmented medial coronoid process using quantitative analysis of film density on digitised radiographs. METHODS: Mediolateral view elbow radiographs from Labrador retrievers (n=34) aged between six and 18 months were obtained and digitised. Images from dogs with an arthroscopic diagnosis of fragmentation of the medial coronoid process (n=17) were compared with that of a control population (n=17), and this data subject to statistical analysis. RESULTS: A statistically significant relationship between the presence of increased trochlear notch radiopacity and a fragmented medial coronoid process was identified. Fractional analysis of this area shows the region of greatest difference in radiopacity between normal and fragmented medial coronoid process cohorts to be in the trochlear region of the medial coronoid process of the ulna. A decrease in radiopacity values in the dysplastic group versus the normal cohort was observed for the region of the proximo-caudal ulnar trochlear notch. CLINICAL SIGNIFICANCE: An increase in ulnar trochlear notch radiopacity is a finding associated with fragmentation of the medial coronoid process in Labrador retrievers.

Perception of training needs and opportunities in advanced airway skills: a survey of British and Irish trainees.

BACKGROUND AND OBJECTIVE: We surveyed delegates at the Group of Anaesthetists in Training (UK) meeting to investigate evidence of a training-gap (number of fibreoptic intubations believed to bestow competence vs. number actually performed). METHODS: Questionnaires were distributed to and collected from delegates in person. Questions covered six areas, including experience of fibreoptic intubation and cricothyrotomy, fibreoptic intubation as a specialist skill and ethical issues. RESULTS: We received 221 replies (76%). All trainees believed competence to be achievable with 10 intubations (interquartile range (IQR) 10-20); the median number performed was 2 (IQR 0-4). This was statistically significant for the groups' senior house officers, 1st and 2nd year registrars and 3rd and 4th year registrars; P < 0.0001. Many final year trainees (12/20, 60%) also failed to achieve their competency target. Few trainees had seen or performed any cricothyrotomies (medians 0, IQRs 0-1 and 0-0). Most (195/208, 94%) believed that fibreoptic intubation was a core skill and 199/212 (94%) believed that all should be competent by completion of training. Ten percent (n = 208) felt it unethical to perform an awake training intubation with full consent and 10% believed it acceptable without explanation. Most (82.7%) would fibreoptically intubate an asleep patient (requiring intubation) without consent. CONCLUSION: Trainees reported a gap between their perception of competence and achievement in awake fibreoptic intubation. Simple and complex simulations and structured training programmes may help. Anaesthetists must address the ethics of clinical training in advanced airway management.

Comparison of anatomical tibial plateau angle versus observer measurement from lateral radiographs in dogs.

This study was conducted to compare the anatomical tibial plateau angle (TPA) with that measured by observers from a lateral radiograph of the limb, the hypothesis being that there would not be any statistically significant differences between the observer measured TPA and the true anatomical TPA. Twelve pelvic limbs from skeletally mature greyhound cadavers, without any clinical or radiographic evidence of stifle pathology, were used in this study. The radiographs were taken of each limb in a lateral position with the primary beam centered over the tibial eminences and collimated to include the stifle and tarso-crural joints. For subsequent radiographs, Kirschner wires were inserted to enable identification of the tibial plateau. The TPA was then measured, by three observers, from the plain radiographs and by one observer from the marked radiographs. The mean observer TPA was 24.4 degrees (range 17-30 degrees) and the mean anatomical TPA was 23.8 degrees (range 15-31 degrees). The mean and median discrepancy between the anatomical TPA and the observer TPA was negative and very small (- 0.64 degrees and 0 degrees). The magnitude of the discrepancy between individual measurements made by the observers tended to overestimate small angles and underestimate the large ones, and this trend is statistically significant. These results suggest that the measurements made by observers accurately represent the anatomical slope of the tibial plateau. Therefore, observer TPA is suitable for the planning and assessment of TPLO procedures. However, as the anatomical TPA moves away from a median angle (23.25 degrees) the magnitude of error in the measurement increases.

Clinical efficacy and pharmacokinetics of carprofen in the treatment of dogs with osteoarthritis.

Six medium to large breed dogs with osteoarthritis were treated with 2 mg/kg of racemic carprofen, mixed with their morning feed, daily for 28 days. The treatment significantly (P < 0.01) reduced their mean lameness score, measured on a visual analogue scale, and there was a trend (P = 0.11) for the peak vertical forces exerted on a forceplate to be increased in the most severely affected limb. The plasma concentration-time relationships of the S(+) and R(-) enantiomers were studied for 24 hours after the first dose and after seven days and 28 days. There were no significant differences between the mean pharmacokinetic parameters measured on the three occasions, suggesting that carprofen was not accumulated and that tolerance to the drug did not develop. Although the pharmacokinetic parameters of the S(+) and R(-) enantiomers were generally very similar, there were wide variations both between and within dogs.

Radial carpal bone fracture in dogs.

In a retrospective study, 11 radial carpal bone (RCB) fractures in nine dogs were studied. Chronic lameness was reported in all dogs. Reduced range of motion and soft-tissue swelling of the carpal joints were clinical signs seen most frequently. Three common fracture patterns were identified: oblique fracture with a large medial fragment, sagittal fracture with a small medial fragment, and comminuted fracture. Radial carpal bone sclerosis and carpal osteoarthritis were identified in all dogs. Pancarpal arthrodesis was used to manage 55% of the RCB fractures in this report. Although RCB fracture is not associated with obvious trauma, the fracture mechanism is unknown.

Haemangiosarcoma of the scapula in three dogs.

Three cases of haemanglosarcoma in the scapula of the dog are reported. Two cases were euthanased soon after diagnosis, due to the presence of metastases, while the third was treated surgically and recovered well. However, seven months after surgery, this dog was re-presented with a cervical spinal problem which was presumed to be a metastatic lesion.

Use of the bisphosphonate drug alendronate for palliative management of osteosarcoma in two dogs.

The bisphosphonate drug alendronate was used to suppress bone remodelling and tumour osteolysis as a palliative treatment for two dogs with osteosarcoma, one of the tibia and one of the maxilla. A spiral fracture associated with the tibial tumour healed after it was stabilised with an external skeletal fixator. Both dogs remained comfortable and survived for 12 and 10 months respectively after diagnosis, despite the fact that neither primary tumour was resected.

Pathological fracture of the femur secondary to haematogenous osteomyelitis in a weimaraner.

A seven-year-old male weimaraner developed an acute-onset non-weightbearing pelvic limb lameness without a history of significant trauma. Radiographs demonstrated an oblique fracture of the femur associated with a lytic bone lesion, while cytology and histopathology of the lesion were consistent with osteomyelitis. A pure growth of Streptococcus intermedius was obtained from culture of affected tissue samples. The fracture healed without complication after rigid internal fixation and antibiotic therapy.

Methicillin-resistant Staphylococcus aureus infections in 11 dogs.

Methicillin-resistant Staphylococcus aureus infection was identified in 11 dogs. The infection was associated with surgical treatment especially orthopaedic surgery. Infection after traumatic wounding, and recurrent pyoderma was also seen. Oral antibiotic treatment improved or resolved the infection in nine of the 11 dogs, although the methicillin-resistant isolates were susceptible to relatively few antibiotics.